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General NPI Number Information
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NPI Number | 1609755701
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Entity Type | Organization
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Legal Business Name | INTERMED, PA
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 100 FODEN RD, EAST
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-1715
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Country | US
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Telephone | 207-874-1489
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Fax |
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Provider Business Mailing Address
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Address Line | 100 GANNETT DR STE C
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-5900
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Country | US
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Telephone | 207-828-0361
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Fax | 207-874-1483
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ROGER A. POITRAS
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Credential |
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Telephone | 207-347-2853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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